F Portelli1, F Galli2, L Cattaneo3,4, M Cossa3, V De Giorgi5, G Forte6, G Fraternali Orcioni6, A Gianatti4, A Indini7, A Labianca7, A Maurichi8, B Merelli7, M C Montesco9, M Occelli10, R Patuzzo8, D Piazzalunga11, J Pigozzo12, P Quaglino13, S Ribero13, R Salvatori3, D Saraggi9,14, P Sena15, R Senetta16, B Valeri3, M Tanaka17, M Fukayama17, G Palmieri18, M Mandalà7, D Massi1. 1. Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy. 2. Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy. 3. Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy. 4. Units of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy. 5. Department of Dermatology, University of Florence, Italy. 6. Anatomia e Istologia Patologica, Azienda Ospedaliera Santa Croce e Carle di Cuneo SC, Cuneo, Italy. 7. Units of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy. 8. Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy. 9. Pathological Anatomy and Histology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy. 10. Oncologia, Azienda Ospedaliera Santa Croce e Carle di Cuneo SC, Cuneo, Italy. 11. Units of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy. 12. Melanoma and Esophageal Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy. 13. Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Turin, Italy. 14. Department of Pathology, Azienda ULSS8 Berica-San Bortolo Hospital, Vicenza, Italy. 15. Units of Dermatology, Papa Giovanni XXIII Hospital, Bergamo, Italy. 16. Pathology Division, Department of Oncology, University of Turin, Turin, Italy. 17. University of Tokyo, Japan. 18. Unit of Cancer Genetics, ICB-CNR, Sassari, Italy.
Abstract
BACKGROUND: The presence of ulceration has been recognized as an adverse prognostic factor in primary cutaneous melanoma (PCM). OBJECTIVES: To investigate whether the extent of ulceration (EoU) predicts relapse-free survival (RFS) and overall survival (OS) in PCM. MATERIALS AND METHODS: We retrieved data for 477 patients with ulcerated PCM from databases of the Italian Melanoma Intergroup. Univariate and multivariable Cox proportional hazard models were used to assess the independent prognostic impact of EoU. RESULTS: A significant interaction emerged between Breslow thickness (BT) and EoU, considering both RFS (P < 0·0001) and OS (P = 0·0006). At multivariable analysis, a significant negative impact of EoU on RFS [hazard ratio (HR) (1-mm increase) 1·26, 95% confidence interval (CI) 1·08-1·48, P = 0·0047] and OS [HR (1-mm increase) 1·25, 95% CI 1·05-1·48, P = 0·0120] was found in patients with BT ≤ 2 mm, after adjusting for BT, age, tumour-infiltrating lymphocytes, sentinel lymph node status and mitotic rate. No impact of EoU was found in patients with 2·01-4 mm and > 4 mm BT. CONCLUSIONS: This study demonstrates that EoU has an independent prognostic impact in PCM and should be recorded as a required element in pathology reports.
BACKGROUND: The presence of ulceration has been recognized as an adverse prognostic factor in primary cutaneous melanoma (PCM). OBJECTIVES: To investigate whether the extent of ulceration (EoU) predicts relapse-free survival (RFS) and overall survival (OS) in PCM. MATERIALS AND METHODS: We retrieved data for 477 patients with ulcerated PCM from databases of the Italian Melanoma Intergroup. Univariate and multivariable Cox proportional hazard models were used to assess the independent prognostic impact of EoU. RESULTS: A significant interaction emerged between Breslow thickness (BT) and EoU, considering both RFS (P < 0·0001) and OS (P = 0·0006). At multivariable analysis, a significant negative impact of EoU on RFS [hazard ratio (HR) (1-mm increase) 1·26, 95% confidence interval (CI) 1·08-1·48, P = 0·0047] and OS [HR (1-mm increase) 1·25, 95% CI 1·05-1·48, P = 0·0120] was found in patients with BT ≤ 2 mm, after adjusting for BT, age, tumour-infiltrating lymphocytes, sentinel lymph node status and mitotic rate. No impact of EoU was found in patients with 2·01-4 mm and > 4 mm BT. CONCLUSIONS: This study demonstrates that EoU has an independent prognostic impact in PCM and should be recorded as a required element in pathology reports.